Stone G W, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Ligon R W, Hartzler G O
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
J Am Coll Cardiol. 1990 Mar 15;15(4):849-56. doi: 10.1016/0735-1097(90)90285-w.
This study analyzes the results of angioplasty in 905 consecutive patients with 971 total occlusions. The procedures were performed by five cardiologists from January 1980 to January 1989 at one institution. The overall success rate per lesion was 72%. Even the most experienced operator (524 occlusions attempted) has continued to improve on a learning curve, with 83% of his most recent 100 occlusions successfully dilated. Procedural death occurred in seven patients (0.8%), five patients (0.6%) sustained a myocardial infarction and seven patients (0.8%) required urgent coronary bypass surgery. Complications were significantly more likely to occur in the elderly, in women and in patients with triple vessel disease and depressed left ventricular function. Compared with angioplasty in 6,950 patients with nonoccluded stenoses, angioplasty of total occlusions had a lower success rate (72% versus 96%, p = 0.001), although the complication rate was also lower (1.9% versus 3.5%, p = 0.01). Multivariate analysis of 20 clinical and angiographic variables in 100 consecutive patients undergoing angioplasty of 104 total occlusions in 1988 identified only bridging collateral vessels (85% success rate if absent versus 18% if present, p less than 0.001) and a tapered occlusion morphology (88% success rate if present versus 59% if absent, p = 0.01) as independent correlates of procedural outcome. Other variables, including the estimated duration of occlusion, lesion length and location, and extent of disease were unrelated to technical success. With present techniques and sufficient operator experience, 70% to 80% of total occlusions can be successfully recanalized by coronary angioplasty with a complication rate of less than 2%.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究分析了905例连续患者共971处完全闭塞病变的血管成形术结果。这些手术由五位心脏病专家于1980年1月至1989年1月在同一机构进行。每处病变的总体成功率为72%。即使是最有经验的术者（尝试了524处闭塞病变）也仍在学习曲线上不断进步，其最近100处闭塞病变中有83%成功扩张。手术死亡7例（0.8%），5例（0.6%）发生心肌梗死，7例（0.8%）需要紧急冠状动脉搭桥手术。并发症在老年人、女性、三支血管病变和左心室功能减退的患者中更易发生。与6950例非闭塞性狭窄患者的血管成形术相比，完全闭塞病变的血管成形术成功率较低（72%对96%，p = 0.001），尽管并发症发生率也较低（1.9%对3.5%，p = 0.01）。1988年对100例连续接受104处完全闭塞病变血管成形术患者的20项临床和血管造影变量进行多因素分析，仅发现桥接侧支血管（不存在时成功率为85%，存在时为18%，p小于0.001）和逐渐变细的闭塞形态（存在时成功率为88%，不存在时为59%，p = 0.01）是手术结果的独立相关因素。其他变量，包括估计的闭塞持续时间、病变长度和位置以及病变范围，与技术成功无关。采用目前的技术并具备足够的术者经验，70%至80%的完全闭塞病变可通过冠状动脉血管成形术成功再通，并发症发生率低于2%。（摘要截选至250字）
